Appendicitis is an important clinical emergency and a common cause of severe abdominal pain. The primary treatment for acute appendicitis is surgery. Despite the advances in diagnostic and therapeutic procedures, appendicitis is still a major health burden. This assignment is based on a case study of Anne, a ten-year-old girl, who has been diagnosed and treated for appendicitis. The first part of the paper will discuss the pathophysiology of appendicitis. In the second section, it will explore the nurse’s role in offering developmentally suitable nursing care. This section will specifically discuss growth and developmental theories; family centred care and impacts of hospitalisation of the child.
The pathophysiology of acute appendicitis starts with obstruction of the appendicular lumen. In children, the obstruction of the appendicular lumen is primarily caused by lymphoid hyperplasia (Schlossberg, 2015). Lymphoid hyperplasia is associated with viral illnesses like gastroenteritis, mononucleosis or upper respiratory infection. However, there are several other causes of the obstruction. These causes include foreign bodies, gastrointestinal parasites and Crohn’s disease (Elgazzar, 2014). Some tumours such as adenocarcinoma and carcinoid tumours. Luminal obstruction results in accumulation of distal secretions as well as intraluminal pressure, which leads to the impairment of venous outflow. Once the venous outflow is impaired, the arterial inflow is also affected adversely. The increase in intraluminal pressure results in tissue ischemia, transmural inflammation, overgrowth of bacteria, appendiceal infarction and eventually, perforation (Elgazzar, 2014). The progress from obstruction to perforation always occurs over 72 hours. Inflammation might consequently extend into the parietal peritoneum and close structures leading to abdominal abscesses.
Narsule and colleagues found that appendiceal perforation is more prevalent in children, especially young children, compared to adults. The study unravelled that the chance of perforation within 24 hours of development of obstruction was 7.7 percent, and the risk seemed to increase with duration of symptoms (Narsule, Kahle, Kim, Anderson, & Luks, 2011). In the case study, Anne presented with a gangrenous perforated appendix with peritonitis. The perforated appendix is characterised by an obvious defect in the wall of the appendix. A thick and purulent peritoneal fluid is also noticeable in the perforated appendix. The perforated appendix might be linked to ileus or bowel obstruction. On the other hand, the progression of gangrenous is related to suppurative appendicitis. A gangrenous appendix is characterised by edematous, congested vessels and fibrinopurulent exudates. Another characteristic is the increase in peritoneal fluid, which might be clear or turbid. It might be walled off by omentum, mesentery or adjacent bowel (Schlossberg, 2015).
In the first stages of acute appendicitis, the client might experience periumbilical pain because of the T10 innervation of the appendix. However, as the inflammation elevates, an exudate deposits on the appendiceal serosal surface. A severe pain, just like in the case of Anne in the case study, occurs when the formed exudates touch the parietal peritoneum (Ryan-Wenger, 2007). Moreover, perforation leads to the discharge of bacteria and inflammatory secetion into the abdominal cavity. As a result, peritonitis develops. The severity and location of peritonitis tend to differ based on the degree of which the omentum and proximate bowel loops can control the spillage of luminal contents.
Nurses in pediatric should understand the child’s physical, cognitive and psychosocial developmental stand to offer quality care. Three important growth and developmental theories are psychosexual development by Sigmund Freud, Erikson’s theory of psychosocial development and Piaget’s theory of cognitive development.
Oral (0-1 years): An infant experiences pleasure mainly from the mouth, with sucking (Thurston, 2014). The oral behaviour of an infant also helps relieve tension, and it plays a vital role in the formation of ego.
Anal (1-3 years): At this developmental stage, the child derives pleasure from the anal. Children can control body secretions.
Phallic (3-6 years): The child takes pleasure in their genitals. Children start touching their sexual organs. At this developmental stage, child struggles with sexual passion towards the opposite sex parent.
Latency (6-12 years): At this stage, sexual desires tend to subside. Children start to focus on other activities associated with cognitive and social growth.
Genital (12 years to adulthood): Sexual desires re-emerge at this stage and adolescents practice appropriate sexual behaviour (Thurston, 2014).
The nurse should explain to Anne what treatments and procedures she will undergo. Based on Freud’s theory, Anne will place importance on her privacy. The nurse should thus provide gowns, covers and inner wears to enhance the privacy of Anne. Another method of enhancing privacy is to close the pediatric ward door and knock before entering.
Trust vs mistrust (0-1 years): Trust is promoted by the delivery of food, clean clothing, comfort and touch (Kail & Cavanaugh, 2015). In case, the caregivers fail to offer basic needs, infants learn to mistrust others.
Autonomy vs shame and doubt (1-3 years): The independence of the toddler is exhibited by the ability to control body excretions and motor activity. Children who are condemned for failure to control motor activity tend to develop shame and doubt in their capabilities.
Initiative vs guilt (3-6 years): At this stage, children met more individuals outside of the family. As such, children are exposed to new activities and start to explore the world. However, continuous criticism results in a feeling of guilt.
Industry vs inferiority (6-12 years): At this developmental stage, children develop new interest and focus on cognitive and intellectual development. The children are pleased with their accomplishments in school, sports, and home. A sense of inferiority develops if children are unable to accomplish what is expected.
Identity vs role confusion (12-18 years): As adolescents enter adulthood, they identify with certain values and roles (Kail & Cavanaugh, 2015). The adolescents who are unable to identify a meaningful definition of self-tend to face confusion in one or several roles of their life.Appropriate nursing care
Based on Erikson’s theory, Anne has already gained a sense of self-worth due to involvement in various activities. The nurse should encourage Anne to bring special pastimes to the hospital. Also, the nurse should encourage the child to continue schooling.
Sensorimotor (0-2 years): At this developmental stage, infants learn by input obtained through the senses and by their motor activity (Shaffer & Kipp, 2010).
Preoperational (2-7 years): Although logic is not fully developed at this stage, children think by using words as symbols. Children exhibit egocentrism and rely on transductive reasoning.
Concrete operational (7-11 years): At this stage, there is a transition from transductive reasoning to the more precise knowledge of cause and impact.
Formal operational (11 years to adulthood): At this age, the mature intellectual thought has already been achieved (Shen & Hendren, 2014). Adolescents are unable to think clearly and make rational decisions.
Appropriate nursing care
According to Piaget’s theory, children between 6-12 years are capable of mature thought. Hence, the nurse should explain to Anne the clear details about the treatment. The nurse should also show Anne the equipment that is being used in treatment.
The illness of a child, like the case of Anne, can have a traumatic impact on both the family and the child. As a result, pediatric nurses adopted family centred care to enhance the well being of children and their family (Harrison, 2010). In the case of Anne, the concept should be a collaboration of the nurses and family to design, deliver and evaluate care. The pediatric nurses should work with Anne’s family to design the best plan care possible for Anne. This approach is attributable to the fact that parents know their children better than the nurse. Anne’s family including her siblings is the primary source of support. Family centred care would be an appropriate choice of offering support in this traumatic period in Anne’s life. A close collaboration between the family and nurses will also reduce the child’s and parent’s anxiety (Saleeba, 2008).
The parent’s role in pediatric care might be unclear in some cultures. However, most parents acknowledge that respect, support and collaboration are fundamental aspects in family centred care concept (Gill, et al., 2014). Several difficulties arise in family centred care due to the poor communication, and insufficient knowledge concerning how the approach functions. Different perceptions of the family might also cause misalignment in the interactions between family members and the nurses.
As noted in the case study, Anne’s parents run an Indian restaurant, which insinuates they are Indians. The Indian culture is very specific regarding reincarnation pain. Some Indian families might prefer that acute care emphasizes on symptoms management as well as control of the child’s pain. In some case, Indians might prefer to avoid caring for the acutely ill child and instead focus on spiritual needs of the child (Wiener, McConnell, Latella, & Ludi, 2013). This organisation might disrupt family centred care infective and delay the recovery process.
Children are affected differently by hospitalisation based on their abilities to cope with stress. Stress is the primary effect of child hospitalisation because the children are separated from their families and supportive environment. Most children tend to experience emotional disturbance because of the hospitalisation experience (Kortesluoma, Punamäki, & Nikkonen, 2008). Emotional upset is also common in children who are separated from their parents for a long period. Personal factors like the child’s temperament and intelligence result in their style of coping with long-term and short-term hospitalisation. When Anne remains in the hospital for ten days, she might become emotionally upset or develop stress because the environment is unfavourable. Just like the hospitalised child, the whole family specifically the parents, tend to develop stress and anxiety (Tehrani, Haghighi, & Bazmamoun, 2012). The level of impact on the family will, however, depend on the ability to develop resilience.
Conclusion
Appendicitis is associated with a wide array of risk factors. Lymphoid hyperplasia is, however, the leading factor for the occurrence of acute appendicitis in children. As discussed in this assignment, lymphoid is linked to several main viral infections such as gastroenteritis and mononucleosis. Anne has undergone surgery to treat appendicitis and thus requires close care, which would be offered by nurses in collaboration with the family. Full disclosure of the treatment procedures and privacy are some of the approaches that the nurses should use when caring for Anne. Finally, there is a probability that Anne will experience emotional upset, and the family will suffer stress and anxiety.
References
Elgazzar, A. (2014). Synopsis of Pathophysiology in Nuclear Medicine. Springer.
Gill, F., Pascoe, E., Monterosso, L., Young, J., Burr, C., Tanner, A., et al. (2014). Parent and staff perceptions of family-centered care in two Australian children’s hospitals. European Journal for Person Centered Healthcare. European Journal for Person Centered Healthcare , 1 (2), 317-325.
Harrison, T. M. (2010). Family Centered Pediatric Nursing Care: State of the Science. J Pediatr Nurs , 25 (5), 335-343.
Kail, R., & Cavanaugh, J. (2015). Human development: A life-span view. Cengage Learning.
Kortesluoma, R., Punamäki, R., & Nikkonen, M. (2008). Hospitalized children drawing their pain: the contents and cognitive and emotional characteristics of pain drawings. Journal of Child Health Care , 12 (4), 284-300.
Narsule, C., Kahle, E., Kim, D., Anderson, A., & Luks, F. (2011). Effect of delay in presentation on rate of perforation in children with appendicitis. AM J Emerg Med , 29 (8), 890-893.
Ryan-Wenger, A. (2007). Core Curriculum for Primary Care Pediatric Nurse Practitioners. Mosby Elsevier.
Saleeba, A. (2008). The importance of family-centered care in pediatric nursing. School of Nursing Scholary Works , 18, 1-7.
Schlossberg, D. (2015). Clinical infectious disease. Cambridge University Press.
Shaffer, D., & Kipp, K. (2010). Developmental psychology: Childhood & adolescence. Cengage Learning.
Shen, H., & Hendren, R. (2014). Child and adolescent psychiatry for the specialty board review. Routledge.
Tehrani, T., Haghighi, M., & Bazmamoun, H. (2012). Effects of stress on mothers of hospitalized children in a hospital in Iran. Iranian journal of child neurology , 64 (3), 39.
Thurston, C. (2014). Essential Nursing Care for Children and Young People: Theory, Policy and Practice. Routledge.
Wiener, L., McConnell, D., Latella, L., & Ludi, E. (2013). Cultural and religious considerations in pediatric palliative care. Palliative & supportive care , 11 (1), 47-67.
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